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Optimizing Opioid Prescribing In Trauma Patients: A Quasi-experimental Study
*Katherine Tyson, *Basil S Karam, *William J Peppard, *Rachel Morris, *Patrick Murphy, *Anuoluwapo Elegbede, *Lewis Somberg, Mary Schroeder, *Colleen Trevino
Medical College of Wisconsin, Wauwatosa, WI

Objectives: It is well established that patients prescribed higher opioid dosages are at a higher risk of overdose and death despite achieving no added long-term pain reduction. Yet increases in opioid prescribing continue to fuel the epidemic in the US. We hypothesized that implementing a comprehensive guideline to standardize opioid prescribing would decrease the dosages prescribed at discharge for trauma patients.

Methods: This quasi-experimental study compared opioid prescribing by trauma providers before and after the implementation of a departmental guideline on April 1, 2019 (Figure 1), aimed at aligning opioid prescription patterns with CDC recommendations. Patients prescribed opioids between April and December 2018 were assigned to the control group, whereas those prescribed opioids between April and December 2019 were assigned to the intervention group. Our primary outcome was the proportion of patients receiving ≥ 50 Morphine Milligram Equivalents (MME) per day.

Results: We identified 293 and 280 trauma patients in the control and intervention group, respectively. There were no differences between the two groupsí ISS (p=0.688) or the frequency of having a procedure performed (p=0.799). Total MME and maximum MME per day were 16% and 25% lower, respectively, in the intervention group as compared to the control group (p<0.001). The proportion of trauma patients prescribed ≥ 50 MMEs per day decreased from 57% to 18% after policy implementation (p<0.001). The proportion of trauma patients prescribed ≥ 90 MMEs per day also decreased, from 37% to 14% (p<0.001). There was no significant increase in the frequency of refill requests (p=0.105) or refill prescriptions (p=0.099) after discharge. (Figure 2)

Conclusion: A departmental guideline aimed at optimizing opioid prescription patterns is successful in lowering the amount of MMEs prescribed to trauma patients and thereby improving compliance with CDC best practice recommendations.
Figure 1: Major changes included in the new guideline

Figure 2: Comparison of prescription patterns between groups

Control Groupn=293Intervention Groupn=280
Opioid Prescribedp=0.155
Oxycodone232 (79%)230 (82%)
Tramadol45 (15%)34 (12%)
Others47 (6%)%)16 (6%)
Total MME Prescribed*225 (150-365)188 (112-262)p<0.001
Max MME/day*60 (30-90)45 (30-45)p<0.001
Max MME/day ≥ 50167 (57%)50 (18%)p<0.001
Max MME/day ≥ 90109 (37%)38 (14%)p<0.001
Maximum Supply (days)*4.2 (3-6.1)5 (3.3-6.7)p=0.101
Maximum Supply > 7 days48 (16%)38 (14%)p=0.346
Refill Requested Post-discharge73 (25%)54 (19%)p=0.105
Refill Prescribed Post-discharge71 (24%)52 (19%)p=0.099

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